天津医药

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全膝关节置换治疗内翻型膝关节性关节炎

刘军1,曹建刚1,2,张宇1,田孟强3,王磊1,2,孙云波1,2,孙振辉1   

  1. 1. 天津市人民医院
    2.
    3. 天津市人民医院骨关节科
  • 收稿日期:2010-09-30 修回日期:2011-02-15 出版日期:2011-06-15 发布日期:2011-06-15
  • 通讯作者: 刘军

Treatment of the varus knee osteoarthritis by total knee arthroplasty

  • Received:2010-09-30 Revised:2011-02-15 Published:2011-06-15 Online:2011-06-15

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摘要： 目的：分析全膝关节置换（TKA）治疗内翻型膝关节骨性关节炎的手术经验及临床效果。方法：采用TKA治疗内翻型膝关节骨性关节炎患者800例(939膝)。男246例（296膝），女554例（643）膝；年龄45～85岁。参照改良Krackow分型，Ⅰ型480例（512膝）；Ⅱ型225例（278膝）；Ⅲ型93例（147膝）；Ⅳ型2例（2膝）。对手术情况、术后影像学、KSS评分及并发症进行分析。结果：本组单膝平均手术时间（60±7）min。66膝骨缺损进行植骨或垫块填充，随访1～4年除深部感染5例外无假体松动发生。术后7～10 d X线检查提示胫股关节角（TFA）与术前比较差异有统计学意义（P＜0.05）。除2例死亡之外其余患者均获随访，时间1～4年。术后4年KSS临床评分和功能评分与术前比较差异有统计学意义（P＜0.05）；根据内翻角度分型的Ⅰ、Ⅱ、Ⅲ型患者术后4年KSS评分比较差异无统计学意义（P＞0.05）。800例患者中52例出现不同程度并发症（6.5%）。结论：TKA是治疗内翻型膝关节骨性关节炎的有效方法，短期随访膝关节功能恢复良好，改良Krackow内翻膝分型方法对术中软组织松解、骨缺损填充具有一定指导意义。

关键词: 全膝关节置换, 内翻畸形, 软组织平衡

Abstract: Objective To analysis the experiences and results of total knee arthroplasty on the varus knee osteoarthritis. Methods From January 2006 to May 2009, 800 patients (939 knees) with varus osteoarthritis were treated by TKA in our hospital, male 246 patients (296 knees), female 554 cases (643 knees); aged 45 to 85. Based on modified Krackow classification: Ⅰ type: 480 patients (512 knees); Ⅱ type 225 patients (278 knees); Ⅲ type: 93 cases (147 knees); Ⅳ type 2 cases（2 knees）. The postoperative imaging and KSS score and complications were analyzed. Results The average unilateral knee surgery time was 60±7 min. 66 knee underwent bone defect filling. After 1-4 years follow-up no prosthesis loosening was found except 5 cases of deep infection. Imaging: preoperative varus angle 6°～ 30°, average 18.6°±1.2 °; weight-bearing X-ray post TKA revealed TFA 5°～7 °, average 5.8°±0.6°. KSS score: After 4 years, the clinical score and functional scores were 86.4±8.4、86.0±9.7, significant difference was found compared with presurgery (P<0.05); no significant difference was found in the three groups classified by varus angle (P＞0.05). 52 cases occurred different degrees of complications in 800 patients (6.5%). Conclusion TKA is an effective treatment method for the end stage of varus-type osteoarthritis of the knee, the function restored well in the short time follow up, and modified Krackow classification had some indicating value in the soft tissue release and bone reconstruction.

Key words: total knee arthroplasty, varus deformity, soft tissue balance